New Report Compares Local Health Systems

The Commonwealth Fund has released the first-ever Scorecard on Local Health System Performance, providing U.S. communities with comparative data to assess the performance of their health care systems.

The 43 indicators in the Scorecard span four dimensions of health system performance: (1) access; (2) prevention and treatment; (3) costs and potentially avoidable hospital use; and (4) health outcomes.

The report compares all 306 local health care areas (known as hospital referral regions) in the United States and shows that access, quality, costs, and health outcomes all vary significantly from one local community to another. The findings clearly illustrate that where Americans live matters for health care access and care experiences. The full report, including an interactive map, is available online.

The top-performing areas in the United States are concentrated in the Upper Midwest and Northeast. Yet, ample opportunities exist for health system improvement in all communities. Not only does the Scorecard allow communities to assess performance, it also provides them with an opportunity to establish priorities for improvement and to set achievement targets.

The percentage of uninsured adults ages 18 to 64 ranged from a low of about 5 percent in several areas of Massachusetts to more than half in the two areas in Texas with the highest uninsured rates. In all communities, children were more likely than adults to have insurance coverage, largely because of federal and state policy attention, though there were places where more than 20 percent of children lacked coverage.

The rate of potentially preventable deaths before age 75 from causes amenable to health care in the area with the highest (worst) rate was more than three times as high as in the area with the lowest (best) rate (169.0 vs. 51.5 deaths per 100,000 population).

The proportion of older adults who received recommended preventive care was more than twice as high in the best-performing area than in the worst-performing area (59% vs. 26%). Yet even in areas with the highest rates, too few adults age 50 and older received all recommended preventive care services, such as screening for cancer.

The incidence of unsafe medication prescribing was also highly variable across local areas. The rate among Medicare beneficiaries was four times higher in Alexandria, La., than in the Bronx and White Plains, N.Y. (44% vs. 11%, respectively).

Between the top 10 percent and bottom 10 percent of areas, there was nearly a twofold difference in hospital admission rates for ambulatory care–sensitive conditions such as pneumonia and diabetes among Medicare beneficiaries (4,045 vs. 7,919 admissions per 100,000 beneficiaries).

The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.